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uvuw ca.�v�ua nYCLil.HL1VN - � � �"� •. ,:,Yl
<br />_' � •• F • � � � • : llpplicant To Complete This : orm / � �� 5�' •: ,' • . . ,y •
<br />. . � . . /d �. e? //��' • .
<br />, �' I! more than one buildinq is to bc contructed, submit a separate perrmit app-lica-
<br />.' tloa for each buildin3. �1 separate permit will be issued for each building.
<br />. -��% Ovaer ( ",L'piZo�t,�o ,/j'.�/��c„ .lirrc%�„� 8ni�dinq nddress � L� G�.�f � .L�li�C,
<br />� . � . � � �ddresa � o �liLn-..-,(� �G� Lot_' � Slxk �'
<br />: •
<br />� . �
<br />�. City �Uet.C.. Phone � O � SnbdiVision (Plat) � � •
<br />' �rehitect/Enqineer � • • � � �
<br />_ !,'`+ : . `. j City , Phone Iietes i Bouads (Unplatted) ' •
<br />:., . . s . ' • ' . . -
<br />' ;,•: Oontractor ' Sec. Svp. Rge
<br />- ..� . . .
<br />_ � ;, •` � • ld8ress ' � . .
<br />�
<br />..� . . .:.:�
<br />Citp Phone Bailding Use ��•._�',
<br />• :L; . . . . , . . . . •:h �: �:'...
<br />••� � r� State, I.icense Ni:mber Descr,3.�e Work to Be .Done � y��
<br />�`/.�J �
<br />: '� Ltpization DatB � ._y� �C� �� ✓t-�� � '
<br />�.1: ' � • S1�TCtt PLOT PL:.?i BELOSP' • • �u�-�'J -
<br />_ ':':.� •. .. . .. • Qse of Buildiag
<br />�� ..
<br />�• y ' . - ' " � � , ,,, � • �New ❑ 1lddition ,Q�Repair/Remo::el
<br />� '�. � ' , � • " , � . ;• - �Valuation of Construction S� �O +�-d '
<br />. ,� ... , . � . .
<br />.�►- . � - • : ��• .-.. . .. _ � , PIAT PLAN REQUI?t��IE:1TS . , =
<br />-�. • . . . , . . � � . . : _:
<br />� . . . . r
<br />' i • • • � • � • • • ' Irdicate lot size, nane of streets,
<br />•'� � • ' � . ' ' � •indicate location and width of - -
<br />• . � 1 � • _ � i'. � ' ._ .. _ `•� • alleys, locate pronosed ar.d all •
<br />. • �-� , ' `� . '' • existing baildiays, sho:a distances
<br />_ . � . . �-R= � - � v • • . . °� • . . to propertp lines, show distances
<br />� t � ' between buildings. •
<br />i.� �'� . • . . .
<br />. � . . . . � . . Eot size x ' . ' �
<br />. " . � �.
<br />� . �� :.i- s . , ' , . , _ . '.I.ot area � Sq. Ft.
<br />. . �. S . . .. �: ' � � � . Size of. Bldq. Sa. Ft.
<br />'' �'i . • ' ' Number of Stories
<br />• :: . i • . . . • .. • ' 8asement • ,
<br />'f : . . . \
<br />,� �s..._.- - � • . . ' Signed By / �Ae. ����d; �.�u�� �/fa.�c�,9�c�'�
<br />- . ; -
<br />..''_ • ' �• • •� ' �•• .� For
<br />,' - . • . Owner Phone
<br />_' � DO VOT ��':2T_T5 B�LO[9 THIS LI:IE-POR CITY US Oi7L'1' �.�
<br />✓
<br />. Date Ceceived
<br />_ _ -^ . .
<br />' Plan Caec� :7ucSer '
<br />. �
<br />• tfalnation (��C�-
<br />. . . • Fetnit Fee �c..(� - m G ;.
<br />Plan Check Fee
<br />. ibtal Fee Due �O DU
<br />. Datc Issued _�f%��� . ,
<br />.�
<br />D�e•Zone
<br />Firc 2one
<br />Occunancy Groa�
<br />K'ype of Construction
<br />Occupant Load
<br />Sprinklers Required
<br />. . . . '.
<br />„ • • ;.. . . , �.
<br />. •.; • �, '
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